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1.
A factitious disorder leading to the self-infliction of highly counter-intuitive burns was diagnosed in a middle-aged female. The injuries were otherwise alleged to have been sustained by assault inflicted upon her by an unknown person. The case was diagnosed by medico-legal interpretation of injuries, in spite of a highly deceptive and concocted history by the patient and her husband. The entity was unique in being associated with magnificent primary, secondary and tertiary gains. The exploitation of the morbid sequel to malinger by the patient, and the involvement of the husband for the prolongation of the illness of his wife for financial gains as gaslighting was highly unusual. The self-infliction of injuries over hands is seen in factitious disorder. However, a combination of a guarded self-immersion of the hands and feet in a corrosive by an illiterate female, followed by malingering to earn livelihood is unprecedented in factitious disorders. The delayed presentation which required amputation of all the limbs to save the life of the patient is a glaring highlight of this case.  相似文献   
2.
BackgroundThe occurrence of acute respiratory distress syndrome (ARDS) significantly increases the mortality and morbidity of major burns; there are few laboratory markers that predict the development of ARDS in severe burns. This study was to investigate the relationship between complete blood count (CBC) parameters and the incidence of ARDS in severe burn patients.MethodsAn eight-year retrospective study was performed on 610 severe burn patients who were admitted to the First Affiliated Hospital of Anhui Medical University and Rui Jin Hospital of Shanghai Jiao Tong University from January 2008 to December 2015. The patients were divided into two groups based on the development of ARDS. A blood sample was taken at admission and CBC parameters were examined. Univariate logistic regression analysis was used to evaluate the risk factors for the development of ARDS.ResultsOf these 610 patients, 143 developed ARDS giving a rate of 23.44%. The percentage of deep second degree and full thickness burn, inhalation injury and red blood cell distribution width (RDW) were independently associated with the development of ARDS in severe burn patients. Every 1% increase in RDW was associated with a 29% increase in the risk to develop ARDS.ConclusionsThe findings of this study suggest that an elevated RDW is associated with an increased risk of ARDS and RDW is an independent risk factor in the prediction of ARDS after severe burns.  相似文献   
3.
目的讨论糖尿病患者手部深度烧伤创面修复临床疗效。方法选取2019年4月—2020年4月期间该院收治的118例手部深度烧伤患者作为该次研究对象,根据是否患有糖尿病分为糖尿病组和非糖尿病组,每组59例。两组患者均采用皮瓣、全厚皮和中厚皮进行创面修复治疗,观察两组患者的治疗效果。结果①干预前,糖尿病组和非糖尿病组患者的空腹血糖以及餐后2 h血糖水平差异有统计学意义(t=14.147、4.998,P<0.001);治疗后,糖尿病组空腹血糖为(5.9±1.2)mmol/L,非糖尿病组空腹血糖为(5.5±1.4)mmol/L,差异无统计学意义(t=1.666,P=0.098>0.05),说明糖尿病患者治疗后血糖水平接近正常值;糖尿病组餐后2 h血糖为(7.4±0.4)mmol/L,非糖尿病组餐后2 h血糖为(7.3±0.3)mmol/L,差异无统计学意义(t=1.563,P=0.127>0.05),说明糖尿病患者治疗后血糖水平接近正常值。②糖尿病组患者的手功能恢复优良率为86.4%,与非糖尿病组的98.3%,组间数据差异有统计学意义(χ2=4.330,P=0.037)。结论对于手部深度烧伤患者来讲,在采用相同的床修复方法时非糖尿病患者的治疗效果相对较好,糖尿病患者恢复效果则相对较差,临床对于糖尿病手部深度烧伤患者应给与高度关注,并积极进行进一步治疗。  相似文献   
4.
马亚军  吴宝恩  任可一  高秋芳 《西部医学》2021,33(11):1660-1664
目的 分析大剂量乌司他丁联合谷氨酰胺治疗对早期重度烧伤患者临床疗效、肿瘤坏死因子-α(TNF-α)及动脉氧分压(PaO2)的影响。方法 选取我院2018年7月~2019年12月收治的重度烧伤患者85例,根据纳入排除标准,共选取83例患者作为研究对象,根据治疗方式的差异分为研究组(大剂量乌司他丁联合谷氨酰胺治疗)43例和对照组(常规剂量、乌司他丁联合谷氨酰胺治疗)40例。比较两组临床疗效,对比两组治疗前、治疗3d及12d后炎症因子水平、呼吸功能含量,并观察两组不良反应发生情况。结果 研究组总有效率(97.67%)高于对照组(82.50%)(P<0.05)。治疗后3d 研究组IL-6、IL-8及TNF-α均较治疗前上升,但于治疗12d后达到最低值;同时,治疗后任意时间点研究组IL-6、IL-8及TNF-α均低于对照组(P<0.05)。治疗前,2组呼吸功能各指标比较无差异(P>0.05),治疗后3d 研究组呼吸频率较治疗前降低,PaO2及PaO2/FiO2均较治疗前上升,且治疗12d后达到最低值(峰值);同时,治疗后任意时间点研究组呼吸频率均低于对照组,PaO2及PaO2/FiO2均高于对照组(P<0.05)。两组治疗前IgA、IgG和IgM水平比较无差异,治疗3d后各组IgA、IgG和IgM水平较治疗前显著降低,并于12d升高达到峰值,同时研究组在治疗后各时间点IgA、IgG和IgM水平均高于对照组(P<0.05)。联合组并发症发生率(6.98%)与对照组(2.50%)比较无差异(P>0.05)。结论 大剂量乌司他丁联合谷氨酰胺治疗可改善早期重度烧伤患者体内炎症反应及呼吸功能,提高其免疫功能,疗效佳、安全性高,可在临床推广应用。  相似文献   
5.
BackgroundAccurate resuscitation of pediatric patients with large thermal injury is critical to achieving optimal outcomes. The goal of this project was to describe the degree of variability in resuscitation guidelines among pediatric burn centers and the impact on fluid estimates.MethodsFive pediatric burn centers in the Pediatric Injury Quality Improvement Collaborative (PIQIC) contributed data from patients with ≥15% total body surface area (TBSA) burns treated from 2014 to 2018. Each center's resuscitation guidelines and guidelines from the American Burn Association were used to calculate estimated 24-h fluid requirements and compare these values to the actual fluid received.ResultsDifferences in the TBSA burn at which fluid resuscitation was initiated, coefficients related to the Parkland formula, criteria to initiate dextrose containing fluids, and urine output goals were observed. Three of the five centers’ resuscitation guidelines produced statistically significant lower mean fluid estimates when compared with the actual mean fluid received for all patients across centers (4.53 versus 6.35 ml/kg/% TBSA, p < 0.001), (4.90 versus 6.35 ml/kg/TBSA, p = 0.002) and (3.38 versus 6.35 ml/kg/TBSA, p < 0.0001).ConclusionsThis variation in practice patterns led to statistically significant differences in fluid estimates. One center chose to modify its resuscitation guidelines at the conclusion of this study.  相似文献   
6.
A numerical-based model was developed and implemented to determine the spatial and temporal temperature distributions within skin tissue resulting from thermal contact with a heated and high thermal conductivity metallic medium. In the presence of wet tissue, boiling is likely to occur, thereby affecting the probability of inducing burns. This investigation deals with how contact between a hot, highly conductive metallic material and skin gives rise to burns. In particular, the study focuses on the likelihood that metals typically used in cooking or industrial applications may cause burns. Insofar as the surfaces under consideration are above the boiling temperature of water, a mathematical model including phase change was developed. That model allowed different thermophysical properties to be respectively employed for dry and wet tissues.Multiple processes and their governing parameters were investigated to assess their impact on burn severity, including the temperature of the metal, the duration of contact, the contact resistance between the surface and the skin, the temperature range over which phase change occurred, and the cooling environment after the exposure. It was discovered that the most important parameters are the surface temperature and exposure duration. The other conditions/parameters had lesser impacts on the results.  相似文献   
7.
8.
PurposeThe study was performed to estimate the diagnostic blood loss (DBL) volume during hospitalization and investigate its relationship with the development of moderate to severe hospital acquired anemia (HAA) and increased number of red blood cell (RBC) transfusion following extensive burns.Materials and methodsThis was a retrospective study of adult burned patients with total body surface area (TBSA) burn larger than 40%, who were admitted to burn center of Changhai hospital between January 2005 and December 2017.ResultsWe included a final number of 157 patients in the present study. Moderate to severe HAA within the fourth week postburn was developed in 46 of 121 patients who stayed over 28-day hospitalization. Patients with moderate to severe HAA had both significantly higher total DBL volume [245 (IQR: 183.75, 325.25) mL vs 168 (119, 163) mL ; P = 0.001] and DBL volume per day [10.22 (IQR: 8.57, 12.38) mL vs 6.63 (5.22, 10.42) mL/day; P = 0.005]. Logistic regression analysis revealed that both DBL volume per day and TBSA burn were independent risk factors for the development of moderate to severe HAA.ConclusionsSeverely burned patients appear to be prone to develop HAA during hospitalization. The DBL volume contribute to the occurrence of moderate to severe HAA, which might be a modifiable target for preventing HAA.  相似文献   
9.
目的探究上肢涡流水疗法治疗上肢烧伤术后疤痕增生患者的临床疗效。方法回顾性分析于我院2016年12月~2018年12月接受治疗的98例上肢烧伤术后疤痕增生患者的临床资料,并根据其治疗方法进行分组,其中对照组48例予以压力疗法、超声波治疗等常规治疗,观察组50例在对照组基础上给予上肢涡流水疗法进行治疗。比较两组患者治疗前及治疗3个月后的瘢痕状况、上肢功能及生活质量变化情况。结果治疗3个月后,两组患者柔软度、血管分布、厚度、色泽得分及总分均较治疗前显著下降(P均<0.05),且观察组明显低于同期对照组(P<0.05);治疗3个月后,两组患者上肢FMA及MI得分均较治疗前显著提升(P均<0.05),且观察组明显高于同期对照组(P<0.05);治疗3个月后,两组患者生活质量各项评分均较治疗前显著升高(P均<0.05),且观察组明显高于对照组(P<0.05)。结论在常规治疗的基础上采用上肢涡流水疗法可有效促进上肢烧伤术后疤痕增生患者的上肢功能恢复,还可改善日常生活能力。  相似文献   
10.
IntroductionFor extensive burns, autologous donor skin may be insufficient for early debridement and grafting in a single stage. A novel, synthetic polyurethane dermal template (NovoSorb® Biodegradable Temporising Matrix, BTM) was developed to address this need. The aim of this study was to evaluate use of BTM for primary dermal repair after deep burn injury.MethodsA multicentre, prospective, clinical study was conducted from September 2015 to May 2018. The primary endpoint was % split skin graft take over applied BTM at 7–10 days after grafting. Secondary endpoints included % BTM take, incidence of infection and adverse events, and scar quality to 12 months after BTM application.ResultsThirty patients were treated with BTM and delayed split skin grafting. The % graft take had a mean of 81.9% and % BTM take had a mean of 88.6%, demonstrating effective integration of BTM. When managed appropriately, it was possible for BTM to integrate successfully despite findings suggestive of infection. Scar quality improved over time.DiscussionThese results provide additional clinical evidence on the safety and performance of BTM as an effective dermal substitute in the treatment of patients with deep burn injuries.  相似文献   
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